Chest Pain

Different body systems and organs can cause discomfort in the upper torso, or chest. Many people always think first of the heart, and whether they are having a heart attack. This is understandable – unfortunately this is a relatively common occurrence in certain patient groups – but it’s also a survival mechanism that means that any pain in the chest is central to survival, and your body is primed to respond with the utmost urgency and priority.

A heart attack is caused by one of the arteries to the heart muscle getting completely blocked – you'll get sudden pain in the centre or left of your chest, it might feel crushing, like someone is sitting on your chest, and pain my go into your left arm or neck. You may be sweaty and breathing fast, you’ll look pale and clammy, and you’ll feel very unwell.

Angina occurs when one of these arteries gets temporarily blocked, often on taking exercise – similar symptoms, but they should ease within a few minutes of rest.

You may get achey or stabbing chest pain with inflammation around the heart (pericarditis) or the heart muscle (myocarditis). And chest pain that travels from front to back and feels particularly severe or searing may suggest aortic dissection, a particularly serious condition that threatens your aorta, the largest blood vessel in your body.

In the lungs, blood clots can block the blood flow to the lungs, called a pulmonary embolus, making you feel very unwell and possibly making you cough up blood – this is serious and needs urgent attention.

Lots of coughing can cause strain on the intercostal muscles, between the ribs, and chest infections can also lead to inflammation of the membrane surrounding the lungs causing chest pain (pleurisy). Asthma attacks can cause a feeling of tightness across the chest. Chest pain can sometimes be caused by a collapsed lung (a pneumothorax) and sometimes high blood pressure in the blood vessels of the lung (pulmonary hypertension.

Gatric acid reflux (heartburn and stomach ulcers can be felt as a painful chest pain behind the breastbone, especially after eating or when lying down, as the excess stomach acid rises. Problems affecting your ability to swallow can also cause chest pain. Abdominal pain can sometimes be referred to the chest with conditions like gallstones.

A common cause of chest pain that has a less serious outlook is any strain to the muscles of the chest wall or between the ribs, and this can be caused by anything from coughing fits, to a sporting injury or weight training - it's worse on breathing deeply or lifting or twisting anything. Direct trauma to the chest can injure muscle and ribs – a cracked rib is very painful, especially on taking a deep breath in.

The cartilage between the breast bone and ribs can become inflamed, leading to a painful condition called costochondritis – it's made worse if you press on edge of the breast bone. Shingles across one side of the chest can cause severe nerve pain and a blistering rash.

When people have a panic attack, they may experience a range of symptoms from their heart beating fast or hard, breathing quickly, sweating, dizziness and chest pain too. These feelings are so uncomfortable that it's hard for people not to envisage that they are experiencing a heart attack, and they may need urgent help the first time, until they can address their anxiety and learn to recognise and manage the symptoms.

If you experience any of these symptoms you should call 999 or make your way immediately to the emergency department:

• Sudden chest pain that spreads either to the arms, neck, jaw or round to the back. 

• Chest pain that feels heavy, like an elephant is sitting on your chest, or tight, making it difficult to breathe. 

• Chest pain that lasts longer than 15 minutes or is associated with shortness of breath, sweating or nausea. 

For anything that does not fit with life-threatening conditions as described, either try to manage mild symptoms at home or – if the diagnosis is unclear or self-care has not helped – book an appointment with your doctor.

Your doctor or the emergency department doctor may be able to determine the cause from listening to your symptoms, and taking note of any relevant medical conditions, family conditions or risk factors. They will take your blood pressure, pulse and breathing rate, and they will examine your heart and lungs.

If they have specific concerns, they may order blood tests, an ECG (electrocardiogram), to look at the electrics of the heart, and a chest X-ray, to look at any heart inflammation or lung infection. If this is an emergency, like a heart attack, pulmonary embolus or pneumothorax, this will be done on the same day in the emergency department.

Any abnormalities will be addressed as urgent, and for heart problems, you may be referred to a cardiologist, who may suggest other specialist investigations. These include a CT scan, an echo, which is an ultrasound scan to look at the structure of the heart, or an angiogram, where dyes are inserted into heart vessels via a tube visualised with X-rays, to identify any strain or blockage in the heart.

Treatment very much depends on the cause.